Need Help with the Marketplace - Just Ask Us

We know how confusing navigating everything on Healthcare.gov can be! We have been studying the health care reform law, obamacare, since 2010 when the law was passed.  We understand the plans, the subsidies, the rates and possible cost sharing options.  Just give us a call and we can walk you through the process and answer all of your questions.

We are insurance agents, not navigators.  Marketplace Navigators can not discuss costs or give advice on which plan would be best for you because they are not licensed.  We can discuss everything about your
coverage options.  Also, if you are not eligible for a subsidy we can help you find overage off of the marketplace.

Give us a call, we can help!  740.967.0210

Use-it-or-lose-it is Gone! (Sort of)

The U.S. Department of the Treasury and the IRS on  issued a notice today modifying the longstanding “use-or-lose” rule for health flexible spending arrangements (FSA). Participants now can carry over up to $500 of their unused balances remaining at the end of a plan year.

The rule will go into effect for the 2014 plan year.

Estimating Your Income

When you apply for lower costs in the Marketplace, you’ll need to estimate your income for 2014.

You can start by adding up the following items for:

• You and your spouse, if you are married and will file a joint tax return 
• Any dependents who make enough money to be required to file a tax return 

For each of the following sources, estimate what your income will be in 2014:

• Wages 
• Salaries 
• Tips 
• Net income from any self-employment or business (generally the amount of money you take in from your business minus your business expenses) 
• Unemployment compensation 
• Social Security payments, including disability payments--but not Supplemental Security Income (SSI) 
• Alimony 

Other items to include when estimating your 2014 income are: retirement income, investment income, pension income, rental income, and other taxable income such as prizes, awards, and gambling winnings.

DON’T include the following: 

• Child support 
• Gifts 
• Supplemental Security Income (SSI) 
• Veterans’ disability payments 
• Workers’ compensation 

For more information on reporting your income, see IRS Publication 525.

More information is available on our website at www.CreeekstoneBenefits.com. 

Reporting on Your Household

We have had lots of questions about who to include in the number of people in your household when trying to determine your subsidy amount.   Here is a quick summary:

When filling out your application, DO include: 

• Yourself 
• Your spouse 
• Your children who live with you, even if they make enough money to file a tax return themselves 
• Your unmarried partner who needs health coverage 
• Anyone you include on your tax return as a dependent, even if they don’t live with you 
• Anyone else under 21 who you take care of and lives with you 

DON’T include:

• Your unmarried partner who doesn’t need health coverage and is not your dependent 
• Your unmarried partner’s children, if they are not your dependents 
• Your parents who live with you, but file their own tax return and are not your dependents 
• Other relatives who file their own tax return and are not your dependents 

To learn more about who qualifies as a dependent, refer to IRS Publication 501. (Excellent reading material if you can't sleep!)


More information is available on our website at www.CreeekstoneBenefits.com. 

Applying Online for Health Insurance with a Subsidy

1. What is a subsidy?

A subsidy will pay a portion of your health insurance premiums. 

2. Do you qualify for a subsidy?
Do you have group/employer coverage that is available to you? This can be through your employer or your spouse/partner’s employer. If you do, you are probably NOT eligible for a subsidy. If you have questions, please contact us. 740.967.0210

Your household must make less than 400% of the Federal Poverty Level (FPL) to qualify for a subsidy. FPL is generally based on the combined income of everyone in your household and how many people are living with you. If your household income is over 400% you do NOT qualify for a subsidy. 

3. If you do qualify, you can go to www.Healthcare.gov to apply online for coverage.
You will need to create a user name and password. Once you have done this you will receive an email. You will need to click a link in the email they send you to verify your email. (Usually there are 3 emails. The email verification seems to be the first one you receive)

4. In order for us to be your agent and help you in the future you will need to enter the information below on the “Help applying for coverage” screen:

         First Name:            Last Name:              FFM User ID:                     NPN Number:
           Tiffany                  Geiger                    tiffany740                             3241172



5. You will need to enter some additional information including:
Social Security Numbers for everyone needing coverage
Dates of Birth for everyone needing coverage
Estimated 2014 Modified Adjusted Gross Income (MAGI)


6. You will be asked to submit the application – you are NOT applying for coverage at this point.
This step is only to verify how much of a subsidy you will receive.

Once you receive your subsidy amount you will be allowed to view plans and rates. Please contact us for assistance.  740.967.0210

More information is available on our website at www.CreeekstoneBenefits.com. 

Medical Mutual Offers Members Prilosec OTC® at No Cost at Participating Pharmacies

Good news—Medical Mutual members living in Ohio can now get Prilosec OTC (or its generic equivalent, over-the-counter omeprazole) without a prescription and at no out-of-pocket cost at a local Discount Drug Mart pharmacy. Drug Mart joins Ohio Rite Aid and Marc’s pharmacies, which also offer Prilosec OTC and OTC omeprazole at no out-of-pocket cost to our members. 

We will send a letter and voucher to members who have filled a prescription for a Proton Pump Inhibitor (PPI)

within the last 180 days, but who have not used Prilosec OTC or prescription-strength omeprazole. Medical Mutual fully insured and administrative services only (ASO) group and individual members who have a prescription drug benefit to receive Prilosec OTC for a $0 copay will be included in the mailing. 

Additional vouchers are available on My Health Plan. Registered members should log into the portal, click Benefits & Coverage then Prescription Drug. The Get Prilosec OTC for free! Link is at the bottom of the Express Scripts tab for members to download and print the voucher. Members can also call our Customer Care Center to request another voucher.

From Medical Mutual of Ohio September 24, 2013 | Broker

Employers Must Issue Notices to Workers By Oct 1

Notices about the health insurance exchanges must to be given to current workers no later than Oct. 1, 2013.  Starting Oct. 1, the notices have to be given to new workers on the day they are hired.

We are recommending that your print the notice and enclose them in your employees paycheck.

Here are the notices and other relevant information:

• If you offer health insurance
• If you do NOT offer health insurance
• Frequently Asked Questions
• Sample Cover Letter
• Tracking Form
• Technical Release (Excellent sleeping material!) 

Sample Exchange (AKA Marketplace) Notice Cover Letter

Employer Letterhead

Dear __________________

Effective October 1, 2013, you and/or your family members may purchase health insurance coverage through a new health insurance marketplace, instead of taking coverage through the employer's health plan. Any coverage you purchase in the health insurance marketplace will be effective on January 1, 2014, if you and/or your family member enroll on or before December 15, 2013. You and/or your family members may purchase health insurance coverage through the health insurance marketplace no later than March 31, 2014, but the effective date of such coverage will vary depending on the date of enrollment.

We are required by federal law to provide you with the attached notice. The purpose of this notice is to inform you of the existence of the health insurance marketplace, give you a description of the services provided by the health insurance marketplace, and tell you how to contact the health insurance marketplace to request assistance.

In addition, this notice helps you determine whether you are eligible for a premium tax credit or a cost-sharing reduction through the health insurance marketplace. You may be eligible if the employer's plan's share of the total cost of benefits is less than 60%, the coverage is unaffordable, or if you are not eligible for the coverage.  The health insurance marketplace will qualify you for any premium tax credit or a cost sharing reduction.

Finally, the notice informs you that if you purchase coverage through the health insurance marketplace, you may lose any employer contribution toward the cost of employer-provided coverage.

If you have any questions regarding this notice, please contact __________________________ at _________________.

Sincerely,

________________________________

Signature

(Title) 

Letter provided  by Attorny Larry Grudsien  http://larrygrudzien.com/

Download a copy of the notice here:

• Notice if you offer group insurance 
• Notice if you do NOT offer group insurance

Healthcare Reform Acronyms

It's no wonder we are all confused. Here's are some acronyms that you may come across when reading about healthcare reform.

ACA	Affordable Care Act
ACO	Accountable Care Organization
ADA	Americans with Disabilities Act of 1990
AHO	Accountable Health Organization
APFC	Advanceable Premium Tax Credit
ARRA	American Recovery and Reinvestment Act of 2009 ("Stimulus Bill")
AV	Actuarial Values
BIIP	Basic Health Plan
CHlP	Children's Health Insurance Program, enacted 1977
CHlPRA	Children's Health Insurance Program Reauthorization Act of 2009
CMS	Centers for Medicare & Medicaid Services
CO-OP	Consumer Operated and Oriented Plan
DOL	Department of Labor
ECP	Essential Community Provider
EHB	Essential Health Benefits
EHR	Electronic Health Record
ESI	Employer Sponsored Insurance
FEHBP	Federal Employees Health Benefits Program
FFS	Fee-For-Service
FLSA	Fair Labor Standards Act
FMAP	Federal Medical Assistance Percentage
FPL	Federal Poverty Level
FQHC	Federally Qualified Health Center
FR	Federal Register
FT   or  (FTE)	Full Time   (Full Time Equivalent)
GF	Grandfathered Health Plan
HCR	Health Care Reform
HHS	U.S. Department of Health and Human Services
HIEorHIX	Health Insurance Exchange
HlM	Health Insurance Marketplace
HIT	Health Insurance Tax
HIPAA	Health Insurance Portability and Accountability Act of 1996
HRP	High Risk Pools
HRSA	Federal Health Resources and Services Administration
IFR	Interim Final Rule
MA	Medicare Advantage
MAGI	Modified Adjusted Gross Income
MEC	Minimum Essential Coverage
MedPAC	Medicare Payment Advisory Commission
MV	Minimum Value
OEP	Open Enrollment Period
PEPM	Per Employee Per Month
PMPM	Per Member Per Month
PPACA	Patient Protection and Affordable Care Act (same as ACA)
PT	Part Time
PTC	Premium Tax Credit
QHP	Qualified Health Plan
SEP	Special Enrollment Period
SHOP	Small Business Health Options Program
SSI	Supplemental Security Income
TANF	Temporary Assistance for Needy Families program

2013 Federal Poverty Guidelines and Premium Subsidies

Beginning in 2014 the amount some pay for health insurance will depend on their annual income.
 Below we have listed the Federal Poverty Level for the 48 states as well as a chart to help explain the subsidies.

48 Contiguous States and DC

Note: The 100% column shows the federal poverty level for each family size, and the percentage columns that follow respresents income levels that are commonly used as guidelines for health programs. 

Household Size	100%	133%	150%	200%	300%	400%
1	$11,490	$15,282	$17,235	$22,980	$34,470	$45,960
2	15,510	20,628	23,265	31,020	46,530	62,040
3	19,530	25,975	29,295	39,060	58,590	78,120
4	23,550	31,322	35,325	47,100	70,650	94,200
5	27,570	36,668	41,355	55,140	82,710	110,280
6	31,590	42,015	47,385	63,180	94,770	126,360
7	35,610	47,361	53,415	71,220	106,830	142,440
8	39,630	52,708	59,445	79,260	118,890	158,520
For each additional person, add	$4,020	$5,347	$6,030	$8,040	$12,060	$16,080

 From: Families USA

If you and your family are at 400% or below Federal Poverty Level you will be eligible to receive a subsidy from the government to help cover part of your private insurance premiums.  Your maximum premium will be determined as a percentage of your annual household income.

For Example: 

A single person making $35,000 per year would pay approximately $277 per month for a silver level plan.  

A single person making $17,235 per year would pay approximately $57 per month for the same plan and have a reduction in out of pocket costs.

Premium Subsidy
Income (% of FPL)	Premium as a Percentage of Income Cap	Reduction in Out of Pocket Limits
Under 133 %	2%	66.70%
150%	4%	66.70%
200%	6.3%	20%
250%	8.05%	N/A
300%	9.50%	N/A
400%	9.50%	N/A